This article by Sandie Rinaldo brought to the forefront major flaws in our long-term-care (LTC) system. We need to overhaul how care is delivered in nursing homes and homes for the aged.

When people seek care in a LTC facility it is because they have multiple and often complex care requirements. To adequately care for these residents, the staffing ratio needs to be increased to accommodate those needs.

People with dementia have very different needs. They require appropriate activation/recreational programs for their age and ability. Just providing a secured floor and using televisions as people-sitters is not enough.

Those residents who are deemed mentally ill do not belong in a regular LTC facility as their care needs are quite different from those of a frail elder. Staff should be trained to manage their care needs and they should be kept apart from the general population.

We live in an aging society where the fastest growing segment of the population is the over-85 age group. Some of those elders will require care. Our current LTC facilities are not equipped to manage their care needs.

Come on elders, seniors, mature adults — let’s hear what you want when you have care needs. Maybe by banding together we can lobby the Ontario government to make the necessary changes so that when we need care, it will be there for us.

Jill L. O’Donnell, seniors consultant, Toronto

We appreciate the coverage of the issue of violence in LTC homes.

The current Ministry of Health and Long-Term Care, and those before it from all three major political parties, have shown little political will to increase the numbers of full-time, consistent staff in LTC homes, despite numerous expert reports recommending that this be done. People should tell their MPPs how they feel about this and make it an election issue.

The majority of people in LTC have dementia and, increasingly, people with mental health issues are being added to the mix. Homes are ill-equipped to do the 24-hour monitoring that is required to keep them safe. Only an increase in the number of staff will help to alleviate the violence that has become a reality of LTC.

The government also has to put some teeth into the penalties available when LTC companies fail in their legislated duty to protect their residents. Having them prepare a written behaviour management plan after the fact is insufficient.

If the government cannot impose a meaningful penalty on Extendicare for such negligence, or pursue legal action against them, and the police cannot charge them, perhaps the Piccolo family should bring a civil suit against Extendicare for failing to keep their loved one safe.

Marcia Zalev and Lorna E. MacGregor, Toronto

More than 10,000 Canadians abused annually by fellow nursing home residents, Feb. 9

This article brings to light, once again, an unacceptable reality that needs swift and concrete action. LTC homes are being expected to care for residents with serious mental health issues and dementias that often result in aggressive and unpredictable behaviours without adequate resources. This is, by far, the greatest challenge homes are facing in caring for residents.

We know what the deficiencies in the system are and what is needed to fix them: thorough assessments that properly identify behaviourial issues, increased funding for higher staffing ratios that allow for specialized care and attention, wider availability of psychogeriatric support for homes, special units in homes for residents with the potential for aggressive behaviour, and continued funding for staff training.

We also need alternative settings to accommodate people with severe problems who cannot be appropriately cared for in long term care.

There has been the start of some promising initiatives such as specialized staffing to support homes in caring for residents with challenging behaviours through the Behaviourial Supports Ontario program. As well, OANHSS is part of a multi-stakeholder task force, established in the last year, that is working on actions that all sector players can take to help prevent incidents of abuse.

While homes are ultimately held accountable, they cannot make systemic change on their own. This is a complex problem that deserves a more balanced and in-depth examination than what we saw in your article.

Frank Piccolo’s heartbreaking story clearly demonstrates that legislation is not enough to keep residents in LTC safe from each other. It further underlines the challenge of providing quality care to a population that continues be older, sicker, frailer and with more than half suffering from some form of dementia. And it underscores the need for sufficient staffing with additional training to deal with challenging behaviours.

This incident shows the urgent need for the Ministry of Health to act quickly to improve the resident to staff ratio in order to meet the increased care and safety needs of today’s LTC residents.

While not the complete answer, encouragement can be found in the efforts and partnerships of all LTC stakeholders to implement the Action Plan in the report of the independent LTC Task Force on Resident Care and Safety, as well as the work of Behavioural Supports Ontario and the Residents First initiative of Health Quality Ontario.

The violent assaults against Frank Piccolo — at the hand of a neighbouring resident of Extendicare Lakeside — points to the vulnerability of anyone institutionalized in a LTC facility. Currently, there is simply no adequate means of protecting one resident against another for the type of assaults that victimized Mr. Piccolo.

Surely the answer to protecting all residents of LTC from violent assaults would have the Ontario Ministry of Health enact legislation through its Long-Term Home Care Act — by enforcing mandatory supervision by a private uniformed security guard presence for all residents of LTC institutions who have violent tendencies.

With over $2 billion in 2011 revenues and a return on investment to its shareholders of over 10 per cent, Extendicare should have no problem with the provision and expensing of adequate security and protection for its residents who are most vulnerable to in-house violence amongst residents.

Indeed, the cost to the LTC corporate body would be negligible to the dilution of shareholder’s equity, but would provide the most secure and safest environment to all residents in LTC facilities.

A much needed step in the right direction. Is that too much to ask of our health care system?

Bruce H. Bryer, Toronto

I visit Lakeside LTC Centre regularly. Located on the Toronto Rehab Hospital campus on Dunn Ave. Lakeside provides a bright, airy, attractive, clean environment. Facilities, activities, and meals are first-rate. Most of all, the staff are capable, caring, and kind. It’s unfortunate that their fine efforts, 24/7, are overshadowed by one incident (out of over 10,000 across the country) — dreadful and inexcusable though it was, and preventable though it might have been.

Shortly after the incident, the Lakeside Family Council was briefed in detail about the special security problems of caring for residents with serious cognitive and psychiatric disorders, and about the additional strategies put in place at Lakeside to reduce the risk of incidents in the future.

Those of us who spend time in these facilities understand the challenges, and are indebted and grateful to the staff who cheerfully deal with them on a daily (and nightly) basis.

John Percy, Toronto

This case is another one of those not-so-rare incidents that occurred under the watch of the Liberal government. Resident-to-resident and staff-against-resident cases of elder abuse is not a new phenomenon and has been going on for years in nursing homes, along with disturbing numbers of gruesome deaths of residents caused by other residents and through negligence and abusive actions of staff.

Facilities are often well aware of repeat dangerous circumstances and behaviours that could easily put the lives of helpless residents in jeopardy as reported in Mr. Piccolo’s story.

The practice of facilities doing their own investigations, and Ministry of Health investigations with meaningless consequences, has consistently failed to protect residents from harm. The systemic problems in nursing homes have festered and escalated under a system that does not have independent, impartial investigations or credible oversight. The government refuses to acknowledge the obvious failure of the ministry to ensure the safety and well-being of residents and repeatedly refuses to grant oversight authority over nursing homes to the Office of the Ombudsman of Ontario.

Whenever the media spotlights nursing home tragedies, comments made by health ministers are predictable and change nothing: They take these matters “very seriously,” vows are made to “fix” the problems, it’s a “work in progress.” Nothing is said about game-changing strenuous enforcement of the legislation.

Ellen Watson, Aurora

This article is a perfect example of greed in our health care system. This for-profit nursing home needs to worry a little less about profits and a lot more about their clients.

The article states the ratio of care giver to clients as 1:8, but with a violent client in the home that ratio is far from adequate. This is a huge problem across our health care system from acute hospitals to group homes.

Ratios mean nothing when the acuity of care goes up. It just leaves patients in a dangerous situation, as was proven in this story. My heart goes out to this family who have to live every day with the guilt of what happened to their loved one.

Candace Epworth, Aurora

As a member of the Chief Coroner’s Geriatric and Long-Term Care review committee I have been involved in investigating numerous fatal assaults and know how terrible these can be. However a punitive approach to the facilities will simply encourage them to refuse admissions of difficult patients.

This problem will require attention to the entire system of geriatric care. There is no magic number of PSWs that will replace the need for qualified nurses to care for such patients.

It is shocking and deplorable that the attack described in your story took place. The nursing home failed in its obligation to protect the resident. But, before demonizing the nursing home and its staff, it would be productive to look at the root cause of this and similar incidents.

Ontario’s LTC system is badly underfunded. The clearest evidence is the wait time for a place in a LTC home. Even citizens whose need is acute can wait months or even years.

Less obvious is the inadequate staff level that is supported by provincial funding formulas. Residents who are mentally incompetent, yet physically able, require constant staff attention. The attacker in the incident that you reported is an example. The staff needed to provide that attention is not there because the funding will not pay their salaries.

In the present environment, families that can afford it often provide residents with private caregivers to supplement the nursing home staff. For residents who need extra attention but cannot afford it, including the majority who are not aggressive, the quality of life suffers.

If society is to provide properly for those citizens who cannot care for themselves, we must devote more resources to the task. Ultimately that means the we must pay higher taxes, and it means that we must not abdicate responsibility for the operation of LTC homes to the private sector.

I have personal experience with the staff at Lakeside Long Term Care. They are conscientious and caring people. There just aren’t enough of them.